MRI for Low Back Pain: Abnormalities Are Not Linked to Symptoms
Magnetic resonance imaging (MRI) and other imaging studies are not recommended for nonspecific low back pain (LBP). Even so, the use of these tests continues when they aren’t needed. Often treatment isn't any different for patients who have an MRI compared to those who don't.
In this study, patients with nonspecific LBP were given an MRI to look for abnormal changes. The majority of patients in the study had observable changes on MRI. Eighty-nine per cent (89%) had severe disc disease. Only 11 per cent had no pathologic changes visible at any lumbar level. In other words, their discs appeared "normal" at every level.
Pain and disability were measured before and after treatment. These results were compared for patients with and without structural abnormalities. Treatment consisted of Physical Therapy, weight training, or low-impact aerobic exercises and stretching.
Patients with MRI changes did not appear to have greater pain or disability compared to those who didn't have significant changes on MRI. Likewise, the results of treatment with conservative care were not affected by observed MRI changes.
The authors report the number and extent of abnormalities seen on MRI increases with age. The changes observed included disc degeneration, disc bulging, and end plate changes. The authors conclude MRI abnormalities are not linked with severity of symptoms.
Frank Kleinstück, MD, et al. Are "Structural Abnormalities" on Magnetic Resonance Imaging a Contraindication to the Successful Conservative Treatment of Chronic Nonspecific Low Back Pain? In Spine. September 1, 2006. Vol. 31. No. 19. Pp. 2250-2257.